Efficacy of guided bone regeneration using composite bone graft and resorbable collagen membrane in Seibert's Class I ridge defects: radiological evaluation.

The purpose of the study was to evaluate radiologically the efficacy of guided bone regeneration using composite bone graft (autogenous bone graft and anorganic bovine bone graft [Bio-Oss]) along with resorbable collagen membrane (BioMend Extend) in the augmentation of Seibert's class I ridge defects in maxilla. Bone width was evaluated using computerized tomography at day 0 and at day 180 at 2 mm, 4 mm, and 6 mm from the crest. There was a statistically significant increase in bone width between day 0 and day 180 at 2 mm, 4 mm, and 6 mm from the crest. The results of the study demonstrated an increase in bone width of Seibert's class I ridge defects in the maxilla of the study patients.

A short review on minimally invasive implants.

In the last 30 years, the use of dental implants to replace missing teeth has increased immensely. Brånemark pioneered the use of extensive surgical flaps to visualise the surgical field during implant surgery. Since then, several changes have been made to the flap design with aesthetic considerations now being incorporated. Such major innovations have contributed to the wide acceptance of flapless implant surgery. Therefore, it is of interest to describe the various techniques, requirements, advantages and disadvantages of minimally implant surgery.

Gum drop technique with pericardial membrane for treating gingival recession - A case report.

Introduction: Gingival recession was treated with gum drop technique (GDT) along with pericardial membrane, advanced platelet rich fibrin (A-PRF) and injectable platelet rich fibrin (i-PRF) in the defect sites for regeneration of soft tissue. Patient Concerns: Several 3-4 mm of recession sites in the maxillary right and left canine and premolar region. These sites were selected and divided into two groups: A and B based on the application with A-PRF and pericardium, respectively. Probing pocket depth (PPD), clinical attachment level (CAL), recession height (RH), recession width (RW) and keratinized tissue width (KTW) were assessed. The keratinized tissue width (KTW) was measured as the distance between the marginal gingiva and the mucogingival junction. Treatment: The defects were treated with the GDT following irrigation with i-PRF and followed up for 6 months. Both groups achieved significant root coverage which was stable even after 6 months post operatively. Keratinized tissue showed a 1 mm gain with pericardial membrane.

Estimation of GCF and Salivary Levels of NT-proBNP in Systemically Healthy Subjects with Severe Chronic Periodontitis Before and After Periodontal Flap Surgery.

Purpose: The aim of the study was to estimate and compare the Saliva and GCF levels of NT-proBNP in systemically healthy subjects with severe chronic periodontitis before and after periodontal flap surgery. Materials and Methods: Twenty subjects were selected and divided into two groups based on inclusion and exclusion criteria. Healthy Controls: 10 periodontally and systemically healthy subjects. Presurgery Group: 10 systemically healthy subjects with severe chronic generalized periodontitis. Postsurgery Group included Presurgery Group subjects who will undergo periodontal flap surgery. After the periodontal parameters were measured, GCF and saliva samples were collected. Postsurgery Group subjects underwent periodontal flap surgery and both periodontal parameters and GCF and saliva levels were reassessed after 6 months. Results: Presurgery Group showed a higher mean value of plaque index, modified gingival index, probing pocket depth and clinical attachment level when compared to Healthy Controls and it was found to decrease after periodontal flap surgery (Postsurgery Group). Intergroup comparison (Presurgery Group vs Postsurgery Group) of the mean difference of salivary NT-proBNP was found to be statistically significant. GCF levels of NT-proBNP also decreased after periodontal flap surgery but the difference was not statistically significant. Conclusion: NT pro-BNP levels were found to be higher in periodontitis group as compared to the controls. The levels decreased following surgical periodontal therapy, elucidating the role of periodontal treatment on the expression of NT-proBNP as a salivary and GCF marker. NT-proBNP could serve as a potential biomarker for periodontitis in saliva and GCF in future.

Effect of three commercial mouth rinses on cultured human gingival fibroblast: an in vitro study.

AIM: To examine the effect of three commercial mouth rinses (Hexidine 0.2%, Listerine Cool Mint, Betadine 1%) upon cultured human gingival fibroblast proliferation. MATERIALS AND METHODS: Human gingival fibroblasts were cultured and incubated in Dulbecco's Minimum Eagle's Medium containing Chlorhexidine, Listerine, Povidone-Iodine at varying concentrations (1%, 2%, 5%, 10%, 20% and 100% of the given solution) at 37 degrees C for 1, 5 and 15 min. Control cells received an equal volume of Dulbecco's Minimum Eagle's Medium without adding mouth rinses, for similar duration of exposure at 37 degrees C. Following incubation the media were removed, cells were washed twice with medium, supplemented with 10% Fetal Bovine Serum, and fibroblasts in the test and control group were allowed to recover in the same media for 24 h. RESULTS: In all the three groups, the proliferation inhibition was dependent on the concentration of solublized mouth rinses in the cell culture but independent of the duration of exposure to all three mouth rinses. The results showed that all three solutions were toxic to cultured human gingival fibroblasts, Chlorhexidine being the most cytotoxic. It was seen that at dilute concentrations (1% and 2% of given solutions) Listerine was more cytotoxic than Chlorhexidine and Povidone-Iodine. CONCLUSION: These results suggest that Chlorhexidine, Listerine and Povidone-Iodine are capable of inducing a dose-dependent reduction in cellular proliferation of fibroblasts. The results presented are interesting, but to know the clinical significance, further studies are needed.

Subepithelial connective tissue grafts for the coverage of denuded root surfaces: a clinical report.

AIMS AND OBJECTIVES: The aim of this study is to determine the effectiveness of subepithelial connective tissue grafts (SCTG) in the coverage of denuded roots. MATERIALS AND METHODS: A total of 16 sites with > or =2 mm of recession height were included in the study for treatment with SCTG. The clinical parameters, such as recession height, recession width, width of keratinized gingiva, probing pocket depth, and clinical attachment level were measured at the baseline, third month, and at the end of the study [sixth month]. The defects were treated with a coronally positioned pedicle graft combined with connective tissue graft. RESULTS: Out of 16 sites treated with SCTG, 11 sites showed complete (100%) root coverage; the mean root coverage obtained was 87.5%. There was a statistically significant reduction in recession height, recession width, and probing pocket depth. There was also a statistically significant increase in the width of keratinized gingiva and also a gain in clinical attachment level. The postoperative results were both clinically and statistically significant ( P 0.05). CONCLUSION: From this study, it may be concluded that SCTG is a safe and effective method for the coverage of denuded roots.

Hospital periodontal surgery.

Phenytoin-induced gingival overgrowth is a recognized side effect in many cerebral palsy patients using diphenyl hydantoin for the control of seizures. Severe gingival overgrowth in these patients can affect normal masticatory function, lead to poor occlusal development, and compromise esthetics. This report addresses the complex nature of treating phenytoin-induced gingival overgrowth in a mentally retarded 20-year-old female patient. For this patient, full-mouth gingivectomy procedure was performed under general anesthesia in a single session. Post operative follow-up was uneventful. This article discusses major indications, contraindications, and protocols to be followed for periodontal surgical procedures done under general anesthesia.

Defensins in periodontal health.

Defensins are abundant and widely distributed peptides in human and animal tissues that are involved in host defence. Defensins not only have the ability to strengthen the innate immune system but can also enhance the adaptive immune system by chemotaxis of monocytes, T-lymphocytes, dendritic cells and mast cells to the infection site. Defensins also improves the capacity of macrophage phagocytosis. A greater understanding of how these peptides act in the healthy, gingivitis and periodontitis conditions would definitely open new opportunities for identification, prevention and treatment of periodontal diseases. This discussion focuses on recent studies about biological function of defensins in human diseases and animal models.

Changes in Transforming Growth Factor-ß1 in Gingival Crevicular Fluid of Patients with Chronic Periodontitis Following Periodontal Flap Surgery.

INTRODUCTION: The aim of the study was to assess changes in Transforming Growth Factor- ß1 (TGF-ß1) levels in gingival crevicular fluid (GCF) and examine correlation of TGF-ß1 levels and periodontal parameters: probing pocket depth (PPD) and clinical attachment level (CAL) in sites with chronic periodontitis at various time intervals before and after periodontal surgery. MATERIALS AND METHODS: The effects of non-surgical and surgical therapy on periodontal parameters and GCF TGF-ß1 levels in 18 sites affected with chronic periodontitis were assessed upto 6 weeks post conventional flap surgery. GCF was collected and PPD, CAL recorded at Baseline. GCF was collected and PPD, CAL recorded at Pre-surgery and flap surgery performed. GCF was collected from all sites at Two Weeks Post-surgery. GCF was collected and PPD, CAL recorded at Six Weeks Post-surgery. The concentration of TGF-ß1 in GCF was determined using a human TGF-ß1 enzyme immunometric assay kit. RESULTS: Mean TGF-ß1 concentrations were significantly reduced at Pre-surgery, at Two Weeks Post-surgery and at Six Weeks Post-surgery (p<0.05) when compared to Baseline TGF-ß1 values. There was a statistically significant reduction in PPD and gain in CAL following non-surgical and surgical therapy when compared to baseline (p<0.05). CONCLUSION: RESULTS indicate that TGF-ß1 may play a role in the pathogenesis and diagnosis of periodontal disease and could be considered as a disease predictive biomarker.

Resection and Regeneration - A Novel Approach in Treating a Perio-endo Lesion.

The pulp and the periodontium are invariably anatomically and functionally related to each other. Lesions involving both the periodontium and the pulp complicate diagnosis, treatment planning and prognosis. An emerging approach to periodontal therapy is the concept of regeneration. In this case report, a novel combination therapy of a blend of platelet rich fibrin with bone graft and guided tissue regeneration membrane was used in the treatment of a perio-endo lesion of a multirooted tooth. A successful outcome in alleviating patient's symptoms and regeneration was seen.

Short-term effects of nonsurgical periodontal treatment with and without use of diode laser (980 nm) on serum levels of reactive oxygen metabolites and clinical periodontal parameters in patients with chronic periodontitis: a randomized controlled trial.

OBJECTIVE: The aim of this study was to compare the clinical efficiency of a diode laser as an adjunct to scaling and root planing (SRP) in the treatment of chronic periodontitis patients, and also to evaluate the changes in the clinical parameters such as clinical attachment level in teeth with periodontal pockets and blood reactive oxygen metabolites. METHOD AND MATERIALS: A total of thirty patients (mean age 38.2 years) with chronic periodontitis were selected for this study. The patients were randomly assigned into two groups of 15 patients each, as the control group and test group. The control group received only conventional SRP and the test group received conventional SRP and diode laser (GaAlAs)-assisted pocket debridement. The clinical parameters (Plaque Index, bleeding on probing, probing pocket depth, and clinical attachment level) were recorded at baseline and day 60, and the serum levels of reactive oxygen metabolites were estimated at baseline, day 30, and day 60 for both the groups. RESULTS: When the groups were compared, there was statistically significant improvement in Plaque Index score, decrease in bleeding on probing and probing pocket depth, and gain in clinical attachment level (P < .001) in both the groups from baseline to day 60. There was significant reduction in reactive oxygen metabolites in both the groups from baseline to day 30 and day 60 (P < .001). However no statistically significant changes were present between the treatment groups from baseline to day 60 in terms of clinical parameters and blood reactive oxygen metabolites. CONCLUSION: From the results observed in this study it can be concluded that use of diode laser as an adjunct to SRP did not provide any significant difference compared to use of SRP alone in terms of clinical parameters and reactive oxygen metabolites.

An overview of frenal attachments.

Frenal attachments are thin folds of mucous membrane with enclosed muscle fibers that attach the lips to the alveolar mucosa and underlying periosteum. Most often, during the oral examination of the patient the dentist gives very little importance to the frenum, for assessing its morpholology and attachment. However, it has been seen that an abnormal frenum can be an indicator of a syndrome. This paper highlights the different frenal attachments seen in association with various syndromic as well as non-syndromic conditions.

Effects of tetracycline-containing gel and a mixture of tetracycline and citric acid-containing gel on non-surgical periodontal therapy.

AIMS AND OBJECTIVES: The purpose of this study was to assess the clinical and microbiological effects of a newly developed root-conditioning gel system containing tetracycline and a mixture of tetracycline and citric acid on non-surgical periodontal therapy. MATERIALS AND METHODS: Four anterior teeth from four quadrants with a probing depth of 4-6 mm, in each of the 20 subjects with chronic periodontitis, were subjected to four different modalities of treatment. A total of 80 teeths were divided into four groups of 20 teeth each taken from separate quadrants, on the basis of one of the following four treatments: (1) Root planning alone in first quadrant (RP group); (2) tetracycline-containing gel in the second quadrant (TCG group); (3) root planning plus tetracycline-containing gel in third quadrant (RP + TCG group); (4) root planning plus a mixture of tetracycline and citric acid-containing gel in fourth quadrant (RP + TC-CAG group). Plaque index (PI), sulcular bleeding index, probing pocket depth, and clinical attachment level were measured for 0 day, 8 th week, and 12 th week, respectively. Subgingival plaque samples from each site were collected at the same visits and examined with dark field microscope for proportions of motile rods and spirochetes. RESULTS: From 0 day to 12 th week, PI, sulcular bleeding index, probing pocket depth, and clinical attachment levels decreased significantly in all the groups. From 0 day to 12 th week, RP + TC-CAG group showed a significantly higher change in the PI score. From 0 day to 12 th week, RP group showed a significantly higher change in sulcular bleeding index score. A significant decrease in probing pocket depth and gain in clinical attachment level was noted at 12 th week in RP + TC-CAG group compared to the other groups. A significant decrease in the proportion of motile rods was found primarily in the RP + TC-CAG group. There was a decrease in the proportion of spirochetes in all the groups. CONCLUSION: The results indicated that the use of a mixture of tetracycline and citric acid-containing gel was effective in improving gingival health and in changing subgingival microflora.

Effectiveness of a controlled release chlorhexidine chip (PerioCol™-CG) as an adjunctive to scaling and root planing when compared to scaling and root planing alone in the treatment of chronic periodontitis: A comparative study.

AIMS AND OBJECTIVES: The aim of this study is to evaluate the effectiveness of a controlled-release chlorhexidine chip as an adjunctive therapy to scaling and root planing when compared with scaling and root planing alone in the treatment of chronic periodontitis. MATERIALS AND METHODS: 20 patients with a total number of 40 posterior sites were selected. These sites were divided into two groups in a split mouth design,: Group A (control site) had 20 sites treated with scaling and root planing alone and Group B (test site) had 20 sites treated with scaling and root planing and PerioCol™-CG. The clinical parameters (Plaque index, bleeding on probing, probing pocket depth, clinical attachment level) were recorded at baseline, 90(th) and 180(th) day for both the groups. RESULTS: When both groups were compared the change in Plaque index was significantly higher in Group B when compared to Group A on the 90(th) day and 180(th) day. However, there was no statistically significant difference in the mean percentage of gingival bleeding sites between the two groups on the 90(th) day, though Group B showed a statistically higher reduction in the mean percentage of gingival bleeding sites at the end of 180(th) day. There was no statistically significant difference in probing pocket depth between the two groups on both 90(th) and 180(th) day. Gain in clinical attachment level was significantly higher in Group B when compared to Group A on the 90(th) and 180(th) day. CONCLUSION: From the results observed in this study, it can be concluded that the adjunctive use of PerioCol™-CG was safe and provided significant improvement in both Plaque index and gingival bleeding index. It was also more favorable than scaling and root planing alone for gain in clinical attachment level.

Effect of a volatile smoke component (acrolein) on human gingival fibroblasts: An in vitro study.

AIM: Tobacco and some of its volatile and non-volatile components have been found to affect many types of cells including human gingival fibroblasts. The aim of this present study was to estimate the effect of acrolein, a volatile fraction of cigarette smoke on the attachment, proliferation and ultra structure of human gingival fibroblasts in culture. MATERIALS AND METHODS: Human gingival fibroblasts strains obtained from healthy subjects aged 20-30 years, were grown to confluency and utilized between 3(rd) -6(th) passages. The cell cultures seeded in 96 well microtitration plates at a density of 45,000 cells/well were incubated with acrolein at concentrations of 10(-4), 3×10(-5) and 10(-5) . Attachment ability was evaluated after three hours using Neubauer hemocytometer. For the proliferation assay cell cultures seeded at a density of 10,000 cells/well were incubated at concentrations of 10(-4), 3×10(-5), 10(-5), 3×10(-6), 10(-6) and cell count determined after 5 days using a hemocytometer. Cell morphology was examined under phase contrast microscope. RESULTS: Acrolein produced a dose-dependent cytotoxic effect on human gingival fibroblasts with complete inhibition of attachment and proliferation at higher concentrations. CONCLUSION: This supports the hypothesis that cigarette smoke is a great risk factor in the development and progression of periodontal disease.

Effect of a controlled release device containing minocycline microspheres on the treatment of chronic periodontitis: A comparative study.

INTRODUCTION: Adjunctive therapy with locally delivered antimicrobials has resulted in improved clinical outcomes. The aim of this study was to evaluate the efficacy and safety of locally administered minocycline microspheres (Arestin) in the treatment of chronic periodontitis. MATERIALS AND METHODS: A total of 60 sites from 15 patients in the age group of 35-50 years, who had periodontal pockets measuring 5-8 mm and had been diagnosed with chronic periodontitis, were selected for the study. The selected groups were randomly assigned to either the control group (group A) or the treatment/test group (group B). Only scaling and root planing were done at the base line visit for the control sites followed by local application of Arestin (1 mg). Clinical parameters such as plaque index, gingival index, and gingival bleeding index were recorded at baseline, day 30, day 90, and day 180 in the selected sites of both the groups. Probing pocket depth also was recorded at baseline, day 90, and day 180 for both the groups. RESULTS: A statistically significant reduction was observed in both groups. Group B showed better results than Group A and these differences were statistically significant. CONCLUSION: The results of this study clearly indicate that treatment with scaling and root planing plus minocycline microspheres (Arestin) is more effective and safer than scaling and root planing alone in reducing the signs of chronic periodontitis.